ADHD: Impact on Prison Rehabilitation and Reoffending

The Ministry of Justice’s cross-Government neurodiversity action plan, published in 2022 in response to the independent review, was a step forward in the official recognition of the unmet need around neurodiversity in the criminal justice system. Some promising steps were taken to advance the commitments in the plan, such as the recruitment of more than 100 neurodiversity support managers in prisons and the roll-out of neurodiversity training in some settings. But data remains insufficient and fragmented, as the hon. Member for Upper Bann (Carla Lockhart) said, and that poses challenges to the effective assessment of the impact of interventions. Will the Minister outline what steps the Government are taking to monitor the number and availability of neurodiversity support managers in prisons across the country, and what measurements are being used to assess the impact of their work?

It is important to keep up the momentum behind the neurodiversity action plan. However, the 18-month review and update committed to under the action plan, which was due in early 2024, has not been published. I would be grateful for further details from the Minister on his plans to continue the implementation of the neurodiversity action plan. Will he outline what steps were taken last year and will be taken to implement the plan? When will the 18-month review, which was due in early 2024, be published?

The ADHD taskforce was established in 2024 and recently published an interim report on the state of play in ADHD care, with its final report due this summer. The taskforce has taken a cross-Government approach, rightly recognising criminal justice as a key focus. The taskforce interim report highlights a number of important and pressing issues, particularly the need for better data to understand where and how people with ADHD are interacting with public services; the relationship between education, health and wider support in relation to outcomes for people with ADHD, including contact with the criminal justice system; and the value of earlier intervention.

What steps have the Government taken and will they take to engage with the ADHD taskforce and wider stakeholders to address the barriers and implement the recommendations highlighted in its interim report and forthcoming final report? Many reports show us that people with ADHD are more likely to struggle with impulse control, emotional regulation and memory recall. We understand that those behaviours can lead to early school expulsions, unstable employment and contact with the criminal justice system.

Once someone is in the system, ADHD can affect how they interact with the police, legal advisers, the judiciary, court staff and probation officers. That can increase exponentially the risks around unreliable statements, misunderstood behaviours and disproportionate sentences. Responses to their environment can lead neurodiverse people to exhibit challenging behaviour that could result in their being disciplined or sanctioned, and affect their engagement or consideration for rehabilitation programmes.

Other reports, such as that published in December 2024 by Takeda, on reforming justice and tackling the unseen challenge of neurodiversity in the criminal justice system, have concluded that there is a need to reassess our approach to managing offenders and consider more innovative ways to interrupt the cycle of reoffending. That includes better approaches to addressing the unmet needs of neurodiverse individuals, where conditions such as ADHD may have a direct impact on offending. Does the Minister agree that, in the light of the challenges, criminal justice services should adjust the way people with ADHD are managed, to improve rehabilitation and reoffending outcomes?

Will the Minister address the matter of women who meet the criteria for ADHD in prisons? ADHD in women is often misdiagnosed or missed altogether. Women are more likely to mask symptoms, presenting as anxious, depressed, having eating disorders or as emotionally distressed. That means that for many women and girls their ADHD is often diagnosed late or not at all. More work is needed to understand the experience of women in the criminal justice system who have ADHD. They are likely to experience multiple barriers and may be impacted by co-occurring mental health issues or other disadvantages. For example, one in three women in prison self-harms—the rate is eight times higher than that on the men’s estate—and there is a strong correlation between ADHD in women and self-harming.

These issues are directly relevant to the Government’s wider ambition to reform the way female offenders are managed in England and Wales, including the intention to close one women’s prison and increase the management of female offenders in the community. That in part recognises that many women are imprisoned for lower-level offences. For example, in 2023, theft from shops was cited as the most frequent offence committed by female offenders, accounting for 40% of women’s prison sentences shorter than six months.

Evidence also demonstrates that the incarceration of women can have a broader impact on families and children. Many women are primary carers, and their imprisonment can result in children being displaced, amplifying cycles of trauma and disadvantage over the generations.

The establishment of the Women’s Justice Board presents an opportunity to address these issues, so will the Minister outline whether the board is currently considering neurodiversity and the impact of ADHD on women in prison within its remit? Will the Minister commit to ensuring that ADHD is meaningfully embedded and accounted for in the work of the board in order to ensure that the experiences of women with ADHD in the criminal justice system are a priority? The Government have stated an ambition to address the challenges of prison capacity and to shift the approach taken to women offenders. It is important to recognise that ADHD screening, a coherent care pathway and improved awareness and training in prisons could play a part in achieving that ambition.

In summary, my current membership of the Justice Committee and my membership of the Education Committee during my service here between 2010 and 2015, along with my meeting experts in ADHD and criminal justice more recently, has emphasised to me the need to take a different approach to identifying and supporting neurodiverse prisoners to help those individuals to make new lives and thereby to help the Government to make sure that prison is effective and efficient at turning prisoners’ lives around.

A new campaign focusing on the unique experience of neurodiverse individuals with ADHD in the criminal justice system explores evidence-based opportunities to improve support and outcomes. Will the Minister meet me and representatives of that campaign to discuss the challenges facing individuals with ADHD in the criminal justice system and the steps that might be taken to meet people’s needs and improve outcomes in relation to rehabilitation and reoffending? I have asked a number of questions, which I provided to the Minister and his team. I recognise that he will not necessarily be able to answer eight questions right now, but would he possibly give me the honour, first, of a meeting and, secondly, of a response to my questions?

In addition, the Probation Service has commissioned neurodiversity specialists in five probation regions: Yorkshire and the Humber, the north-west, the west midlands, the south-west, and Wales. Those services offer direct support to people who are diagnosed with or suspected to have a neurodivergent condition; supporting engagement with their orders or licences, they provide briefings to probation staff designed to help them to identify factors that may be related to neurodivergent conditions, and give guidance on how best to support the rehabilitation of these individuals.

The hon. Member for Wells and Mendip Hills asked about neurodiversity support managers. We have neurodiversity support managers in all our public prisons, and they have a whole-prison approach to neurodiversity. That includes: improving processes to identify and support prisoners with neurodivergent needs; providing training and guidance for prison staff; and ensuring that neurodivergent prisoners can access education, skills and work opportunities within the prison.

Neurodiversity support managers also ensure that reasonable adjustments are made to prison environments to make them more supportive of neurodivergent needs. They are frequently recognised in His Majesty’s Inspectorate of Prisons reports for their positive impact in prisons, with recent reports from HMP Kirklevington Grange and HMP Warren Hill highlighting their support for prisoners as an example of good practice.

The 2021 joint inspectorate neurodiversity review of evidence, which the hon. Member for Wells and Mendip Hills cited in detail, suggested that at least 50% of prisoners have a neurodivergent need, although many will not be diagnosed. In response to the review, the previous Government published a cross-Government neurodiversity action plan in July 2022, with updates in the January and September of 2023. I am pleased to tell hon. Members that we will publish a final update to the action plan later this year, which will respond directly to the joint inspectorate’s report and set out a cross-system strategy to further improve outcomes for neurodivergent people, building on the vital work of the ADHD taskforce.

I welcome the publication of the ADHD taskforce’s interim report. It is a timely and important piece of work that outlines the systemic challenges in ADHD services across the country and sets out both short and long-term recommendations to improve support for people with ADHD. Many contributions made by Members highlighted the issues in other services, which is why the report is important. I am grateful to colleagues across Departments who have worked collaboratively to shape the recommendations.

The report rightly makes clear that no single Department can resolve the challenges alone. ADHD, when left unsupported, can lead to a cascade of negative outcomes: school exclusion, unemployment, substance misuse, involvement in crime, and, tragically, sometimes suicide. We will continue to work with the taskforce and together across Government to achieve the report’s aims.

In youth justice, youth offending teams are increasingly tailoring interventions to children’s specific needs, including those with neurodiverse conditions, with 95% of practitioners reporting that assessments and planning now take into account individual vulnerabilities. Where children are detained in youth custody, all children receive a comprehensive health assessment that screens for a range of needs, including mental health and neurodiversity when they first arrive. All education providers across the three public young offender institutions also have a special educational needs co-ordinator who, in collaboration with NHS England, conducts assessments for children who may have undiagnosed needs, including ADHD. We are having a roundtable later today with education providers to look at alternative education providers outside of the youth justice estate to look at ways of bringing their expertise into the youth custody system so that we can learn from others and improve the way we do business in the youth custody service.

The hon. Member for Wokingham (Clive Jones) drew attention to focusing on and analysing needs. His Majesty’s Prison and Probation Service takes a needs-led approach to supporting people in prison, including those with ADHD. This ensures that needs are identified as early as possible so that appropriate reasonable adjustments and support are provided throughout custody. To improve current screening processes, HMPPS is procuring a new needs assessment tool. I am pleased to confirm that Do-IT Solutions has been awarded the contract for this tool, which will be introduced as part of the new prisoner education service. The tool will identify individual strengths and additional learning needs, including those associated with autism spectrum conditions and ADHD.